1. Advancing STD Prevention as Public Health Priority
A View from the Outside: Taking Steps to Improve
STD Prevention
Julie M. Scofield Executive Director 2008 National STD Prevention Conference Chicago, Illinois

2. Introduction to NASTAD A View from the “Outside”? 2008 Lay of the Land
Steps to Improve STD Prevention

3. Introduction to NASTAD
NASTAD is a non-profit national association of state health department HIV/AIDS program directors who administer HIV/AIDS prevention, care and treatment programs funded by state and federal governments.
NASTAD is governed by a 20 member, elected Executive Committee charged with making policy and program recommendations to the full membership.
NASTAD’s Washington, DC headquarters has a professional staff of thirty.

4. NASTAD’s Strategic Map
Central challenge: Assert the role of state public health in addressing the HIV/AIDS and viral hepatitis epidemics.
Overarching strategic priority: Address racial and ethnic disparities in the HIV/AIDS and viral hepatitis epidemics.

5. Prevention and Surveillance Racial and Ethnic Health Disparities
NASTAD Programs
Domestic
Care and Treatment
ADAP TA and Monitoring
Prevention and Surveillance
Racial and Ethnic Health Disparities
Viral Hepatitis
Global Technical Assistance
Government Relations

6. Acknowledgements

7. A View from the Outside?
“The philosophy of science is to find truth. The philosophy of medicine is to use that truth for your patient. The philosophy of public health is to use that science for everyone for social justice in health” William H. Foege, MD, MPH

8. A View from the Outside. (Who are NASTAD members
A View from the Outside? (Who are NASTAD members?) (HIV/AIDS Program Integration with STD, VH and TB Programs)
NASTAD HIV Prevention Program Inventory—Preliminary Data

9. What do AIDS directors say about STD directors?
“I am the STD director!” (over 60%)
“We don’t get along”
“We have philosophical differences - behavioral vs. biomedical”
Others mention racism, homophobia, funding disparities, program silos, disease burden, food chain, politics, etc.
Recommendation #1
Make friends with the AIDS director!

10. “Every public health decision rests on a
2008 Lay of the Land
“Every public health decision rests on a
political decision.”
William H. Foege, MD, MPH

11. 2008 Lay of the Land (Gloom and doom slide)
Cuts to STD funding in recent years
Special interest, disease specific, and program silos aren’t very popular at the moment
FY2009 budget not likely until after the elections
Election year posturing on the Hill
State budgets in trouble
U.S economy in trouble
Spending $720 million a day on war in Iraq
Recommendation #2
Dedicate 2008 to laying foundation for future support!

12. Steps to Improve STD Prevention
“The biggest dilemma in public health and medical ethics is resource allocation….How can we stand by watching $87 billion disappear down the Iraqi drain without presenting a clear picture of what $87 billion could do for public health in this country?” William H. Foege, MD, MPH

13. Steps to Improve STD Prevention
Get over HIV/AIDS envy - STD advocacy is different
“Advocacy” is not a dirty word - tap your inner lobbyist
A rising tide raises all boats - work in coalitions
Work the budget process - the entire process
K.I.S.S. - keep it simple or can I spell syphilis?
Don’t play the “zero-sum” game - unless it is war $$$
Sometimes it IS who you know - the Nancy Pelosi effect
Rome wasn’t built in a day - be in it for the long haul

14. Steps to Improve STD Programs
“Public health leaders can’t stay out of politics.”
William H. Foege, MD, MPH

15. Steps to Improve STD Prevention
STD advocacy is different
Different emergence and history
No grassroots or consumer/client outcry
Tap your inner lobbyist
Who makes STD funding their # 1 priority all the time AND has a presence on the Hill?
When was the last dedicated STD “Hill day?”
Redefine “constituency” and get to the Hill!
3. Work in coalition
Look for likely and unlikely allies
Support the Campaign for Public Health
If you can’t get a seat at the table, make your own table!

16. Steps to Improve STD Prevention
“We ought to make the pie higher”
George W. Bush, Jr.

17. Steps to Improve STD Prevention
4. Work the entire budget process
Need CDC expertise and internal advocacy
Work HHS, OMB, the White House and the Congress
State level advocacy essential as well
Do all steps every year!
5. Keep it simple
Break “STD” down into specific health/disease challenges
Articulate impact with stories, not just data
Quantify simple needs – how much and what for?
What could be accomplished with one day of war money?
Develop simple messages and relationships with media

18. Steps to Improve STD Prevention
6. Don’t play the “zero-sum” game - unless it is war money
The first rule of appropriations advocacy – don’t suggest offsets or suggest that other programs don’t need additional funding.
It is the responsibility of policymakers to find the money!
Sometimes it IS who you know!
A single member with a passion for your issue can make a difference!
Be in it for the long haul
Build relationships over time, particularly with key Hill staff
Policymakers need to hear messages many times from many voices

19. Steps to Improve STD Prevention
Make friends with the AIDS director/ stop comparing
Dedicate 2008 to laying foundation for future support
Tap your inner lobbyist
Work in coalitions
Work the entire budget process
Keep it simple
Don’t play the “zero-sum” game
Find champions
Be in it for the long haul
Do 1-9 and repeat!

20. for social justice” William H. Foege, MD, MPH
“I urge you to use your positions as health officials to make the political system work
for social justice” William H. Foege, MD, MPH

21. National Alliance of State & Territorial AIDS Directors
Contact Information
National Alliance of State & Territorial AIDS Directors
Julie M. Scofield
Executive Director